Provident Health Care Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

PROVIDENT HEALTH CARE INC

Doing business as

PROVIDENTHEALTHCARE-TAMARACK HOME

Practice address

1553 Tamarack Ave
Atwater, CA 95301-2743

Phone

(209) 357-2212

Fax

(209) 557-5689

NPI assigned

Dec 31, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jerry R. Tiu

Title

Owner/Licensee

Phone

(209) 723-4888

Specialties & licenses 1

Addresses

Other names 1

• PROVIDENTHEALTHCARE-TAMARACK HOME Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G589

Legal name

TAMARACK HOME

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jun 30, 1992

Last certification

Jun 11, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

1553 Tamarack
Atwater, CA 95301

Tax ID family

Provident Health Care Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Provident Health Care Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Ahwahnee, CA
  • NPI 1598157604
  NPD tax ID
• Provident Health Care L.L.C

  • Nursing Facility/Intermediate Care Facility
  • Merced, CA
  • NPI 1982853131
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356912000000",
    "number": "1275879801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1238 CATALINA DR",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953489515",
            "telephone_number": "209-723-4888",
            "fax_number": "209-722-7087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1553 TAMARACK AVE",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953012743",
            "telephone_number": "209-357-2212",
            "fax_number": "209-557-5689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-31",
        "last_updated": "2012-12-31",
        "status": "A",
        "authorized_official_last_name": "TIU",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER/LICENSEE",
        "authorized_official_telephone_number": "209-723-4888",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENTHEALTHCARE-TAMARACK HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Akshita Prasad
• Shavina Prasad
• Henry W Pratt, P.A.
• Kelly Primeay
• Debbie Rachelle Prince, P.T.
• Provident Health Care Inc
• Aleeya Punkham
• Arjun Purewal
• Esmeralda Quintero
• Ivett Quintero

• Intellectual Disabilities Intermediate Care Facility in Atwater, CA
• Providers in Atwater, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.